By Andy Bell
Over recent weeks, mental health inpatient services in England have come under intense scrutiny from media exposure of incidences of abuse, cruelty and neglect. Television and newspaper investigations have taken the public to parts of the health and care system that are seldom seen by those without a personal or professional connection to mental health services. They have exposed abuses in both NHS and privately run hospitals and care homes, for both children and adults, in different areas of the country.
These investigations have brought wider attention to systemic faults that have been allowed to go unnoticed (except by those whose lives are affected by them and those who have advocated for reform) for too long. While hospitals that treat people’s physical health are often seen as beacons of ‘our NHS’ that communities proudly rally around, mental health hospital services – and, by implication, the people in them – are hidden away, sometimes still stigmatised, often conveniently placed out of sight. We’re still living with the legacy of historical approaches to mental health that have marginalised people experiencing psychological crises, used coercion (increasingly) as a response to distress, and created restrictive environments and practices as a way of keeping people ‘safe’, against a backdrop of inadequate investment in mental health care.
While hospitals that treat people’s physical health are often seen as beacons of ‘our NHS’, mental health hospital services – and, by implication, the people in them – are hidden away, often conveniently placed out of sight.
At the same time, we hear too often that people in a mental health crisis are left in emergency departments or prison cells for prolonged periods because there isn’t a bed for them. People admitted to mental health hospitals far from home because they can’t be supported locally. Children placed in adult wards. Prisoners kept in cells for weeks and months awaiting a transfer to hospital. These are all distressing signals of a system that is struggling to cope with ever-rising levels of need for mental health support.
In such circumstances, it’s a logical response to call for more mental health beds, so that people aren’t left waiting in acute distress for essential treatment. But does that ultimately place more people at risk of enduring cycles of coercion, restriction and trauma? Are there other ways that the NHS and its partners can respond to people’s needs that don’t go down this path?
Systemic change is inherently more difficult than incremental improvement. Inertia is a powerful force in any system, especially where resources are so restricted and the attentions of system leaders are more often elsewhere.
These hard-won gains could be lost if the NHS is not able to sustain planned funding increases for mental health services in the next five years.
Despite this, the NHS in England has already been working hard to expand and improve mental health services: from creating mental health teams in schools to employing mental health workers in primary care; and from large-scale transformation projects in community mental health to developing better crisis services and regular physical health checks. New Care Models for children’s mental health have demonstrated that it is possible to invest in local services and reduce the risk of children being sent far from home. These are hard-won gains that could be lost if the NHS is not able to sustain planned funding increases for mental health services in the next five years.
Austerity policies too often come at high cost. Cuts to social security, public health and social care budgets have placed heavy burdens on people and families. And this eventually ends up costing the NHS dearly too when people’s health deteriorates. As more people hit crisis point with weaker safety nets, services have few options beyond the use of institutional care.
It’s a cycle that we can end by investing in mental health: by creating the conditions for people to thrive, by providing essential services before people reach crisis point, and by responding with compassion when people need quality care quickly. That doesn’t have to mean more beds. It may mean expanding inpatient services in places that are especially poorly served. But it might also mean expanding community support to enable more people to stay home with the right help, or to leave hospital sooner, with enough money to live on and a warm home to live in (which cannot be guaranteed, especially now). By reducing the pressure on inpatient services, and at the same time investing in modern, fit-for-purpose facilities when they are needed, the conditions for compassionate care are more likely to be created and the potential for abuse curtailed.
it’s up to all of us to find solutions, to rebuild a system that has allowed poor and abusive practice to happen behind closed doors for far too long
Every mental health service (community as well as inpatient) will always need close inspection and easy routes for staff, service users and carers to blow the whistle on abuse, coercion and neglect. But it’s also essential to invest in a workforce that is well-trained, properly supported, trauma-informed and culturally competent. Giving mental health workers the best possible chance to provide compassionate care in an environment where their own wellbeing and safety are looked after is an essential foundation for good quality care, whether they work in a hospital, a community service, digitally or in a school or GP surgery.
We often talk about ‘turning points’ when failings in public services are exposed by the media. It’s easy to say and very difficult to achieve in practice, especially when the public gaze is quickly averted and the impulse for change weakens. So it’s up to all of us to find solutions, to rebuild a system that has allowed poor and abusive practice to happen behind closed doors for far too long, and to make equitable, compassionate care a reality everywhere.
